How To Cure Facial Redness Naturally

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Erythema multiforme is a rare disease in the cat and is usually associated with drug administration, particularly cephalexin, penicillin, aurothioglucose and sulfadiazine. The disease in humans is associated with drug administration, viral diseases and neoplasia. The pathogenesis of the feline disease may be similar to that observed in the dog, with up-regulation of the expression of major histocompatibility complex class II, CD44 and intercellular adhesion molecule-1 on keratinocytes. CD8+ T-lymphocytes are recruited to the epidermis and dermis and these are thought to be responsible for the keratinocyte apoptosis that is a characteristic feature of erythema multiforme. Clinical signs observed in cats include vesiculobullous and ulcerative lesions, or maculopapular eruptions. The lesions are most likely to be found at mucocutaneous junctions and on the trunk. A skin biopsy of a vesicular lesion should reveal histopathological changes of full-thickness necrosis of the epidermis with...

Chronic cutaneous lupus erythematosus is referred to as discoid lupus erythematosus (DLE). It is an eruption that results in scarring and pigmentary changes in the skin. DLE is most commonly seen in African-Americans. Only 10 percent of patients with this type of lupus develop systemic disease. Clinically, the lesions of DLE occur in a photodistributed area, especially on the face, ears, scalp, and neck. The lesions begin as erythematous or hyperpigmented FIG. 238-3. Discoid lupus erythematosus. The external ear and preauricular cheek is a common site of involvement. Central depigmentation with surrounding erythema and hyperpigmentation is typical of discoid lupus erythematosus.

Although discoid lupus erythematosus (DLE) is well recognised as a dermatological entity in dogs it is rarely reported in cats. There is no apparent age, sex or breed predisposition. Clinical signs consist of periocular crusts, erythema, vesicles and papules on the pinnae, and scaling and crusting of the footpads with focal depigmentation. There may be plaque-like erythematous excoriations involving the pinnae, neck, abdomen and groin, or generalised crusting and scaling. Skin biopsies have shown histological changes of

Clinically, the malar rash consists of erythema on the medial cheeks and across the bridge of the nose. Induration, scale, or telangiectasias may be present. Occasionally, the eyelids may be involved which makes the eruption difficult to distinguish from heliotrope rash of dermatomyositis. Diagnosis is based on clinical examination and the presence of other systemic symptoms suggestive of SLE. This eruption is by no means specific for lupus erythematosus. The differential diagnosis includes rosacea, erysipelas, dermatomyositis, seborrheic dermatitis, medication-induced photosensitivity, polymorphous light eruption, and allergic contact dermatitis. Skin biopsy may be helpful especially if the diagnosis is in question. Initial laboratory evaluation includes a complete blood count, chemistry profile to include BUN and creatinine, urinalysis with evaluation of urine sediment, antinuclear antibodies, double-stranded DNA, and complement.

Ataxia telangiectasia (AT) is a rare (1 40 000 live births) pleiotropic disorder whose various pheno-typic manifestations include a progressive cerebellar ataxia, ocular apraxia, and oculocutaneous telangiectasia (Figure 1). Almost all patients have an elevated serum a-fetoprotein (AFP). Translocations involving chromosomes 7 and 14 are characteristic. About half of the patients have a moderate to severe immunodeficiency, involving both B and T cell compartments. One-third of patients develop cancer, usually lymphoid. Because these patients are hypersensitive to ionizing radiation and are cancer susceptible, they are in grave danger of being overtreated with conventional doses of radiation therapy. The disease is inherited as an autosomal recessive trait. Despite previous work describing four complementation groups, only a single AT gene exists, ATM (AT, mutated). Most patients are compound hetero-zygotes, i.e. they inherit a different mutation from each parent. The function of the...

Epistaxis requiring surgery in most patients arises from arterial bleeding. However, in the case of hereditary haemorrhagic telangiectasia epistaxis is due to both arterial and capillary bleeding. Results of any form of therapy, including arterial ligation are poor. These patients usually require a combination of arterial ligation (or embolization) together with local control. It is important to cause as little mucosal damage as possible as there is always need for repeated local therapy. A proactive approach is advisable, it is much more effective to treat and cauterize potential bleeding points regularly than to tackle major epistaxis once in a while. Both the carbon dioxide (CO2) and potassium titanyl phosphate (KTP) lasers have proved useful in the management of this condition.

Erythema multiforme (EM) is an acute inflammatory skin disease presenting across a spectrum. It ranges from a localized papular eruption of the skin (EM minor) to a severe, multisystem illness (EM major) with widespread vesiculobullous lesions and erosions of the mucous membranes, Stevens-Johnson syndrome (SJS). The disorder strikes all age groups with the highest incidence in young adults (age range 20 to 40 years), affects males twice as often as females, and occurs commonly in the spring and fall. Infection, especially mycoplasma and herpes simplex, drugs, especially antibiotics and anticonvulsants, and malignancies are common precipitating factors. However, there is no identifiable etiology in approximately 50 percent of cases. 1 2.41-16 (Plate. 27) lesions are the most characteristic. Erythematous papules appear symmetrically on the dorsum of the hands and feet, and the extensor surfaces of the extremities. The maculopapule evolves into the classic target lesion during the next...

Vaginal cuff cellulitis is a common complication following both abdominal and vaginal hysterectomy. Symptoms and signs usually present between postoperative days 3 and 5, and may begin in the hospital, or just after discharge. Patients often complain of lower abdominal pain, pelvic pain, back pain, fever, and abnormal vaginal discharge. Induration, tenderness of the vaginal cuff, and possibly a purulent discharge or labial edema or erythema are prominent during the pelvic examination. The white blood cell count is usually elevated.

The typical lesion of impetigo contagiosa begins as an erythematous papule. Small vesicles may follow transiently, but rapid progression to crusted lesions occurs. These crusts, which are initially honey-colored and fine in consistency, may appear on any area of the body between the upper lip and the nose is a very characteristic site. The lesions enlarge over days to weeks, and the crusts become thicker. Erythema is mild. No induration is present. In bullous impetigo, the characteristic skin lesions are superficial bullae filled with purulent material. The bullae range in size from 0.5 to 3 cm and have minimal, if any, surrounding erythema.

Typically, however, bilateral tonsillar erythema and exudate will be noted on exam. The uvula and anterior pillar of the tonsil on the affected side may be displaced away from the involved tonsil. The involved tonsil is, as a rule, anteriorly and medially displaced. Cervical adenopathy is often present but does not differentiate this process from the much more common causes of pharyngitis.

FORESKIN PEARLS Secretions and sloughed epithelial cells (smegma) from the surface of the glans penis accumulate under the foreskin and contribute to the gradual elevation and separation of the foreskin from the surface of the glans penis. The thin foreskin may reveal such accumulations of smegma, referred to as foreskin pearls. They ultimately will decompress at the terminus of the foreskin's attachment to the glans penis. If unassociated with evidence of cellulitis (erythema, warmth, induration, and tenderness), they do not represent an infectious complication and require no treatment beyond an explanation and reassurance for the concerned parent.

The presentation of necrotizing fasciitis can vary from the appearances of a simple cellulitis or soft-tissue injury to the classic hemorrhagic bullae, presence of soft-tissue gas, septic shock, and multiorgan failure. Toxic shock syndrome and multiorgan failure were also present in 47 of patients with group A streptococcus necrotizing fasciitis.30 Most cases of necrotizing fasciitis initially present with a cellulitis but progress over hours to days with spreading erythema and edema. Hemorrhagic bullae can form as a result of skin necrosis secondary to vessel thrombosis. Pain out of proportion to clinical findings is commonly reported as an important early sign. Anesthetic skin due to destruction of nerves can be a late sign. Soft-tissue gas is a classic finding especially with clostridial infection. Estimates of the frequency of these signs and symptoms are not available.

PAINLESS SOLID SCROTAL MASSES Idiopathic Scrotal Edema Idiopathic scrotal edema results in painless scrotal erythema and induration in boys from age 2 to 11 years. Two-thirds of cases are unilateral. The etiology remains obscure. No specific allergen has been identified. The child has no complaint of pain but may note minimal pruritis and may exhibit a waddling gait. Erythema and swelling may extend to portions of the phallus, abdomen, and groin. Examination reveals a thickened and edematous scrotal skin and underlying tunics, but the boy has little or no tenderness to palpation of the affected areas. There is no fever. The testes, epididymis, and tunica vaginalis are normal, although the degree of swelling of the scrotal skin may preclude adequate examination by palpation. In sonographic studies done in such extreme cases, the underlying scrotal structures and vascular flow appear normal. The urinalysis results and peripheral white blood cell count are normal. The scrotal edema and...

Urticaria, or hives, is a cutaneous IgE-mediated reaction marked by the development of pruritic, erythemic wheals of varying size that generally disappear quickly. Erythema multiforme is a more pronounced urticarial variant, characterized by typical target lesions. Angioedema is believed to be an IgE-mediated reaction characterized by edema formation in the dermis, most generally involving the face and neck. These manifestations may accompany many allergic reactions. As with all allergic manifestations, a detailed history of exposures, ingestions, medications, and infections and a family history should be obtained. If an etiologic agent can be identified, future reactions may be avoided. Treatment of these reactions is generally supportive and symptomatic, with attempts to identify and remove the offending agent. Epinephrine, antihistamines, and steroids are most often tried. Oral antihistamines and steroids for several days may be beneficial. The addition of an H 2 receptor blocker,...

Colonization of the nipples or the lactiferous ducts by Candida albicans may cause chronically sore nipples during or after lactation. The appearance of the nipple may be normal however, more commonly, scaling, fissuring, and erythema are present. Predisposing factors for candidal colonization include antibiotic use, vaginal candidiasis, mastitis, and nipple trauma occurring in the early lactation period. Definitive diagnosis may be made by fungal culture, but that should not be necessary. The nipples may be treated with topical antifungal creams.4 Vaginal candidiasis in the patient, as well as any clinically evident oral candidiasis in the infant, should also be treated.

Pharyngeal membranes become dry, painful, and cracked because of the dehydration and high ventilation. Mucosal cracks may be an entry for pathogens, or the erythema and dryness may cause discomfort strictly on a mechanical basis. Antibiotics generally are not helpful, supporting the concept of a noninfectious etiology. Breathing of steam, ingesting hard candies or lozenges to increase salivation, and forcing hydration may provide some benefit with systemic analgesics as necessary. A silk Balaclava or similar material across the nose and mouth that is sufficiently porous to allow large volume ventilation but trap some moisture and heat helps ameliorate these bothersome high altitude conditions.

Contact dermatitis results from the exposure of vulvar epithelium and vaginal mucosa to a primary chemical irritant or an allergen. In either case, characteristic local erythema and edema occur. Severe reactions may progress to ulceration and secondary infection. Common irritants and or allergens include chemically scented douches soaps bubble baths deodorants perfumes, dyes, and scents in toilet paper, tampons, and pads feminine hygiene products topical vaginal antibiotics and tight slacks, pantyhose, and synthetic underwear. Clinically, patients report local swelling and itching or a burning sensation. The gynecologic examination reveals an erythematous and edematous vulvovaginal area. Local vesciculation and ulceration are seen more commonly with allergens or when primary irritants are used in strong concentrations. Vaginal pH changes may promote colonization and infection with C. albicans, thus obscuring the primary cause.

The first type involves the external auditory canal and is generally referred to as external ear squeeze, or barotitis externa. The external ear canal normally communicates with the environment and, consequently, the air in the canal is replaced by water when a diver is submerged. However, if the external ear canal is occluded (e.g., by cerumen, foreign bodies, exostoses, or earplugs), water entry is prevented, and compression of the enclosed air with descent will have to be compensated for by tissue collapse, outward bulging of the tympanic membrane, or hemorrhage. This is typically manifested by pain or bloody otorrhea. Physical examination may reveal petechiae or blood-filled cutaneous blebs along the canal, along with erythema or rupture of the tympanic membrane. Treatment involves keeping the canal dry, prohibiting swimming or diving until healed, and, in special cases, taking antibiotics and analgesics. Squeeze can also affect any other gas space that does not equilibrate with...

Mastitis originates in the subareolar ducts and extends outward in the breast. The cause is generally infectious, and the organisms include gram-negative organisms and anaerobes in addition to Staphylococcus aureus. Occasionally, mastitis occurs in areas of cystic breast tissue without an infectious cause. Periductal mastitis may be an evanescent tender breast mass that resolves spontaneously or persistent inflammatory reaction that progresses to abscess formation. Mastitis is manifested by pain, erythema, and warmth of the overlying skin, with exquisite tenderness. Nipple retraction or fistula formation at the edge of the areola occurs frequently with recurrent episodes of periductal mastitis with or without abscess formation.

Cutaneous manifestations of sarcoidosis typically present at disease onset, and with the exception of erythema nodosum, do not correlate with the severity of disease. Erythema nodusum tends to be associated with acute, benign, spontaneously resolving sarcoidosis.2 Skin lesions in sarcoidosis can be divided into specific lesions (i.e. skin biopsy demonstrates non-caseating granulomas) and non-specific lesions (i.e. reactive states). Specific lesions include papules, nodules, plaques, subcutaneous nodules, infiltrative scars and lupus pernio. Plaques and papules are the most common cutaneous lesions, while lupus pernio is most specific for sarcoidosis.3 Lupus pernio tends to affect the face, manifesting as brownish-red, dusky, swollen and shiny infiltrated plaques.1

CICATRICIAL PEMPHIGOID Cicatricial pemphigoid is a chronic vesiculobullous mucocutaneous disorder with an autoimmune etiology. Autoantibodies against the basement membrane result in subepithelial cleft formation. Cicatricial pemphigoid affects people in the seventh decade of life, with no race predilection. The ratio of males to females 1 2.27. Oral lesions are seen in approximately 85 percent of patients, but any mucosal or cutaneous site can be affected. Oral lesions may begin as a desquamative gingivitis or vesiculobullous lesions. Oral lesions eventually become denuded, leaving a painful, erythematous, irregularly bordered erosion or ulcer. Lesions may persist for weeks. Significantly, ocular involvement occurs in 65 percent of cicatricial pemphigoid patients and, if untreated, may lead to blindness. Referral to an ophthalmologist is essential. Diagnosis is by biopsy and immunofluorescent staining of perilesional mucosa. Histologically, the lesions show inflammatory infiltrates...

SARCOIDOSIS Sarcoidosis is a multisystem granulomatous disease with an uncertain etiology. The lungs, lymph nodes, skin, and eyes are affected most commonly. Skin lesions are common and include classic painless erythematous nodules, erythema nodosum, on the extremities. Oral involvement is primarily limited to enlargement of major and minor salivary glands, and xerostomia is a common complaint. Mucoceles of the minor salivary glands are common, and biopsy of these lesions may result in the diagnosis of sarcoidosis.19 MYCOBACTERIAL INFECTIONS Most oral lesions of tuberculosis represent secondary infection from a primary pulmonary infection, but primary oral tubercular lesions can occur. Discovery of oral lesions prior to diagnosis of pulmonary tuberculosis is rare. Prior to effective antitubercular therapeutic regimens, oral lesions were considered a poor prognostic indicator. Secondary oral tubercular lesions are usually painful, irregular, nodular ulcers surrounded by an area of...

CLINICAL FEATURES Bites by Loxosceles spiders are initially painless, prohibiting definitive identification of the spider. The most common manifestation of a Loxosceles bite consists of a mild erythematous lesion that may become firm and heal with little or no scar over several days to weeks. 9 Occasionally, a more severe reaction occurs, with mild to severe pain several hours after the bite. There may be erythema and blister formation and bluish discoloration within the first 24 h ( Fig

Infection is infrequent with the AUS, especially in the more recent models. Recent studies report an incidence of infection in the range of 1.2 to 2.7 percent. Like any foreign body, the AUS causes a tissue reaction, which may facilitate infection if bacteria are present. S. epidermidis and coliform bacteria tend to be the most common etiology for bacterial infection of the device. A patient's presentation may be subtle in cases of infection and requires a thorough history and physical examination, as well as a heightened degree of suspicion. Patients may be afebrile, lack an elevated white blood cell count, and have sterile blood and urine cultures. Others may have pain, swelling, erythema, or induration around the mechanism. In male patients, there may be thinning of the scrotal skin overlying the pumping mechanism (the most common site of infection), and induration or tenderness along the length of tubing may be palpable in the patient. Treatment of this complication includes...

Occasionally, infections will arise in the web space. These collar button abscesses present with pain and swelling of the web space causing separation of the affected digits. Examination reveals induration or fluctuance in the dorsal and or volar web space along with erythema, warmth, and tenderness. S. aureus and Streptococcus species are the most common organisms isolated.9 0 A paronychia is an infection of the lateral nail fold or paronychium (Greek para, beside + Greek onyx, nail). Occasionally this may extend to the cuticle or eponychium (Greek epi, upon + onyx). These common conditions are usually caused by minor trauma such as nail biting, manicures, or hang nails. The infection starts as a small area of induration that may be erythematous and tender.4

Many systemic conditions and local stimuli affect the appearance of the tongue. Asymptomatic deep fissuring of the dorsal surface is common and probably represents a developmental phenomenon. Many systemic conditions, various vitamins deficiencies, and iron-deficiency anemia cause atrophy of the filiform papillae, resulting in a smooth erythematous appearance. Excessive intake of hot, spicy foods also can result in a smooth appearance. Occurrence of ectopic thyroid tissue on the midline posterior portion of the tongue is called a lingual thyroid and is a common finding. Some of the common conditions affecting the tongue not discussed elsewhere will be mentioned here. ERYTHEMA MIGRANS Erythema migrans, geographic tongue, or benign migratory glossitis is a common benign finding on oral examination, occurring in 1 to 3 percent of the population. Females are affected twice as often as males. The typically multiple, well-demarcated zones of erythema on the tongue are due to atrophy of the...

Glucagonomas secrete excess glucagon and result in type 2 diabetes, hypo-aminoacidemia, anemia, weight loss, and a characteristic skin rash, necrolytic migratory erythema. Diagnosis is suggested by symptoms and biopsy of the skin rash but is confirmed by elevated plasma glucagon levels (usually greater than 1000 pg mL). Tumors are large and are readily seen on CT scan. Resection is indicated in fit patients after nutritional support, even if metastases are present.

Erythema multiforme has characteristic findings on the palms and soles. These lesions are erythematous macules with a violaceous, dusky or bullous center. They are commonly referred to as target or iris lesions. Discovering such lesions should incite a search for similar lesions on the rest of the body, hemorrhagic erosions on the mucosal surfaces, and conjunctival hemorrhage in the eyes. Rocky Mountain spotted fever may also present initially with palm or sole lesions. These appear as blanching erythematous macules that later become nonblanching petechial lesions. These lesions start distally and spread proximally. Kawasaki disease, scarlet fever, and toxic shock syndrome may all have palmar erythema as a prominent feature. The palms and soles will desquamate as these diseases progress. FIG. 239-9 (PJateM). Norwegian scabies. The thick scale, erythema, and exudate resemble a foot dermatitis. This disorder should not be forgotten when presented with a patient with extremely pruritic...

It is very common to find erythematous and sometimes bile-tinged mucosa just proximal to the stoma in the operated stomach. Histologically, inflammatory mucosal changes are found in 60-90 of cases. It is likely that the reflux of bile and alkaline pancreatic juice has causal significance. The degree of macroscopic and histological changes does not correlate with the severity of the complaints, and many patients are asymptomatic. The endoscopic picture is characterized by edema, erythema, and mucosal fragility when biliary secretions are present. - Little erythema at the anastomosis

Clinically, allergic contact dermatitis resulting from an aerosolized allergen presents as erythema or scale with or without vesiculation. The involvement is diffuse with upper and lower eyelids affected. This distribution is in contrast with photosensitive eruptions in which nonsun-exposed areas, such as the upper eyelids and the upper lip, are spared. Direct allergic contact dermatitis tends to be most prominent on the most sensitive skin, such as the eyelids. Examples of aerosolized contactants include rhus (poison ivy, oak) when the plant has been burned. Examples of common contactants affecting the face include nickel, nail polishes, toothpaste, preservatives in make-up, contact lens solutions, eyeglasses, and hair care products. Chemical-splash injuries are a common cause of facial-irritant contact dermatitis. A thorough history is necessary to uncover the offending agent. Referral to a dermatologist or allergist may be necessary if the history is unrevealing.

Rocky Mountain spotted fever, a rickettsial infection acquired from tick bites, has a presentation similar to that of TSS, but the rash is usually petechial and delayed in onset. Toxic epidermal necrolysis resembles SSSS and occurs primarily in adults. Non-toxin-mediated, it is related to drug exposure and has a bullous component. Erythema multiforme can be associated with fever, pharyngeal erythema, and toxemia. The rash is multiform, with symmetric involvement of the lower extremities. Immunologically mediated from a drug exposure or infectious agent, it can progress to Stevens-Johnson syndrome.

Exfoliative dermatitis, a cutaneous reaction produced in response to a drug or a chemical agent or to an underlying systemic disease, is a condition in which most or all of the skin surface is involved with a scaly erythematous dermatitis. Males are affected twice as often as females, and most patients are over the age of 40. 10 The mechanisms responsible are not known although drug-induced exfoliative dermatitis may be mediated by an increased activity of sensitized suppressor-cytotoxic T lymphocytes. Generalized erythema and warmth are noted and are similar to that seen in the patient with TEN, but skin tenderness is usually lacking. Erythema is accompanied by scaling or flaking and the patient often complains of pruritus and skin tightness F g ,.241-2 (Plate 28) . The process usually begins on the face and upper trunk with progression to other skin surfaces. The patient usually has a low-grade fever. Excessive heat loss and hypothermia can complicate erythroderma. Widespread...

When a sensitized animal or person re-encounters an antigen, a series of events occurs which results in the clinically recognizable response of contact hypersensitivity. The response is characterized by vasodilation (erythema), edema of both dermis and epidermis, fibrin deposition and the accumulation of an inflammatory infiltrate of monocyte macrophages and lymphocytes. Detectable sensitivity reflects the presence of specifically committed CD4+ lymphocytes circulating and trafficking through the tissues. Their numbers presumably determine the magnitude of the reaction to antigenic challenge thus, in fact, subclinical sensitization could be present if the clone of T cells had not expanded sufficiently to leave the lymph node, although 'memory' would have been established. There is clear evidence that such subclinical sensitization can occur. The extent of the clonal proliferation appears to be proportional to the 'drive' from antigen-bearing Langerhans cells, reflected in the...

Intramuscular injection of phenytoin results in localized crystallization of the drug, and hematoma, sterile abscess, and myonecrosis at the injection site. Complications after intravenous infusion have included skin and soft tissue necrosis requiring skin grafting, and compartment syndrome, gangrene, amputation, and death. A syndrome of delayed bluish discoloration of the affected extremity, followed by erythema, edema, vesicles, bullae, and local tissue ischemia, has also been described.13 The propylene glycol diluent, strong alkalinity of the intravenous solution, and crystallization of the drug contribute. Fosphenytoin by contrast, is well tolerated when given IV or iM.

Ultraviolet light (UVA and UVB) penetrates the atmosphere to a greater degree at high altitude because of less cloud cover, less water vapor, and less particulate matter in the air. Radiation increases roughly 5 percent for every 300 m (1000 ft) gained, and it is exacerbated by reflection back from snow. UV radiation below 300 nm (UVB) is absorbed by the cornea, and high exposure levels can cause corneal burns in 1 h, although symptoms do not become apparent for 6 to 12 h. The typical symptoms of photokeratitis are severe pain, a foreign body or gritty sensation, photophobia, tearing, marked conjunctival erythema, chemosis, and eyelid swelling. UV keratitis generally is self-limited and heals within 24 h, but the condition is sufficiently painful to warrant systemic analgesics. Cold compresses may also provide some relief, and eye patches may be necessary for comfort. Prevention is obviously of great importance, since this condition can be disabling, especially in hazardous terrain....

Propionibacterium spp. require lipid and anaerobic conditions for successful cultivation in vitro. P. acnes and P. granulosum are isolated from highly sebaceous areas of human skin in all those past puberty P. avidum is similarly found in the axilla. The first two species are associated with acne and are occasionally recovered from deep infections in humans. There is no consensus on the role of Propionibacteria in acne. Not all acne lesions contain microorganisms but a potential role for Propionibacteria may be as follows they reside in the ducts of sebaceous glands which become blocked as a result of changes in keratinization sebum continues to be produced so that the blocked duct forms a closed comedo. In vitro, P. acnes has sharp pH and p02 optima for the production of hyaluronidase and protease production of these enzymes in vivo, if it occurs, would render the comedo wall leaky to host-defense mechanisms triggering of the alternative complement pathway by the cell wall of P....

A rare syndrome, also called hepatocutaneous syndrome and superficial necrolytic dermatitis, has been described in three cases, with some features resembling the condition observed in the dog. A pancreatic tumour was diagnosed in a 11-year-old ovariohys-terectomised female Abyssinian cat with gingivitis, stomatitis and hepatomegaly. There was alopecia, erythema and exudation in the axillae. Scaling and patchy alopecia of the distal extremities was noted and the footpads were unaffected. Histological findings of skin biopsies were supportive of a diagnosis of metabolic epidermal necrosis (Patel et al, 1996). However, unlike the usual clinical presentation in the dog, the feet were not affected. In another case the feet were affected and the cat had a hepatopathy (Godfrey &amp Rest, 2000). There is no effective therapy and the affected cat usually undergoes euthanasia.

Reduced endogenous estrogen causes thinning of the vaginal epithelium. Symptoms include vaginal soreness, postcoital burning, dyspareunia, and occasional spotting. The vaginal mucosa is thin with diffuse erythema, occasional petechiae or ecchymoses, and few or no vaginal folds. There may be a serosanguineous or watery discharge with a pH of 5.0-7.0.

In agreement with the observations in immunodeficient animals, in immunodeficicnt patients a higher cancer incidence is also observed. Humoral deficiencies, such as X-linked agammaglobulinemia and common variable immune deficiency, and cellular immunodeficiency syndromes, such as Wiskott-Aldrich syndrome, ataxia telangiectasia, the X-linked

Typical clinical presentations have been described for some specific pathogens. Pneumonia due to S. aureus is notorious for being particularly rapid in the progression of clinical findings. Patients with B. pertussis pneumonia typically develop prodromal symptoms, including mild cough, conjunctivitis, and coryza, that lasts 1 to 2 weeks. A severe, paroxysmal cough often associated with emesis and dehydration, because coughing prevents eating and drinking, is characteristic of the catarrhal phase of pertussis infections. The inspiratory whoop is generally present only in older children. A history of maternal pelvic or conjunctival chlamydial infection is present in up to 50 percent of cases in which the infant develops C. trachomatis pneumonia. An infant with a chlamydial infection is usually afebrile, has a distinct staccato cough (i.e., short, abrupt onset), and diffuse rales on auscultation. Such infants rarely appear systemically ill. Chlamydial pneumonia in adolescents is usually...

The typical lesions of HSV are painful, grouped vesicles with an erythematous base. The primary eruption may be preceded by constitutional symptoms. The characteristic primary eruption is a gingivostomatitis with herpetic lesions on the lips and in the oral cavity. It may persist for weeks. The differential diagnosis includes erythema multiforme, Coxsackie virus, varicella zoster virus, idiopathic aphthae, and, rarely, Behcget's disease and pemphigus vulgaris.

Larregue and colleagues5 compared 6 ammonium lactate (another substance designed to improve water-binding capacity of the skin) against its cream base in 46 children aged 6 months to 12 years with atopic dermatitis. The study was a within-person comparison of two symmetrical sites. Lichenification, hyperkeratosis and dryness were reduced in both groups but slightly more so in the ammonium lactate group. This was reported to be statistically significant at day 15 for lichenification and for erythema at day 30 (the final evaluation point of the study). Tolerability, as evaluated by the patients, was very similar in both groups.

Presenting signs and symptoms of cutaneous infections, including pyomyositis, are fever, pain, localized erythema, and edema. The painful area should be carefully inspected for fluctuance, crepitance, and lymphangitis. Infections over venipuncture sites suggest infected pseudoaneurysms. Pulsatile masses should be imaged with ultrasonography prior to incision and drainage, as attempts to aspirate or incise and drain an infected pseudoaneurysm can result in significant hemorrhage. Angiography may be required to identify vasospasm, thrombosis, emboli, mycotic aneurysms, or septic hematomas. Plain radiographs can demonstrate air in the soft tissues, which may be present even when localized tenderness and erythema are the only findings. CT is useful to clearly delineate the involvement of other structures and the extent of deep abscesses, especially in complex areas such as the neck. Whenever crepitus or subcutaneous air is detected or deep tissue or muscle involvement is suspected...

There are numerous oral manifestations of HIV infection. Primary HIV infection, occurring from 1 to 6 weeks after contact, is an acute viral syndrome but may have associated intraoral findings such as a sore throat, mucosal erythema, and focal ulceration. Persistent generalized lymphadenopathy, particularly of the cervical lymph nodes, is present in 70 percent of otherwise asymptomatic HIV-infected patients. The presentation of acquired immunodeficiency syndrome (AIDS) is highly variable, and numerous oral manifestations can occur. Oropharyngeal candidiasis is the most common oral finding and may lead to the initial diagnosis of AIDS. HIV-related gingivitis is distinctive, presenting as a 2- to 3-mm linear band of erythema along the gingival free margin. Periodontitis among the HIV-infected population is common and usually more aggressive and painful in its presentation. Such necrotizing periodontitis is distinguished from acute necrotizing ulcerative gingivitis, which is also a...

Acute idiopathic scrotal edema (AISE) is a fairly common, yet underreported cause of the acute scrotum in children, accounting for as many as 30 of patients who undergo assessment (Najmaldin and Burge 1987). It is characterized by the rapid onset of nontender, frequently unilateral scrotal and penile erythema and edema. The patient is usually afebrile and is otherwise asymptomatic, apart from the distressing appearance of the genitalia. It is usually found in prepubertal children from 5 to 11 years of age. As the name implies, the cause of AISE is unknown however, some children present with a history of asthma or allergic conditions such as eczema or dermatitis (Klin et al. 2002). Laboratory investigations are usually normal, with occasional Physical examination reveals an edematous, erythematous, hyperthermic scrotal wall without underlying testicular tenderness. The penile shaft skin maybe involved however, there is no history of irritative or obstructive voiding symptoms. Lower...

Wounds should be kept clean and dry for 24 h after suturing. Thereafter, they may be cleaned with running water and covered with a clean, dry dressing. Discharged patients should return for suture or staple removal in 7 to 10 days for upper extremity lacerations, 10 to 14 days for lower extremity lacerations, and 14 days for lacerations over joints. This time can be extended a few days in patients over age 65 years because epithelialization and noncollagenous protein accumulation are delayed.8 Routine antibiotic prophylaxis is not recommended.19 Prophylactic antibiotics are recommended for joint penetration, bite wounds, and in delayed primary closure. For markedly contaminated wounds, which required extensive debridement and irrigation, it is appropriate to reexamine the patient in 48 h for signs of infection and then begin antibiotics if necessary. Patients should be instructed to return for severe pain, erythema, purulent discharge, fever greater than 38.6 C (101.5 F), ascending...

The first step in the telangiectasia formation consists a focal dilatation of postcapillary venules with predominant stress fibers in pericytes along the luminal border. As the venules enlarge, they become convoluted and form excessive layers of smooth muscle cells without elastic fibers and connect directly with the dilated arterioles.1-1-1

Approximately 50 percent of patients on phenytoin will develop significant gingival hyperplasia. Many other medications are known to cause gingival hyperplasia, such as calcium channel blockers, especially nifedipine, and cyclosporine. Concomitant use of two agents known to cause gingival hyperplasia results in accelerated gingival proliferation. With phenytoin hyperplasia, enlargement begins in the interdental papillae. Characteristics of the gingival tissue depend on oral hygiene and secondary inflammation. In the absence of inflammation, gingival proliferation results in dense tissue, normal in coloration, with a smooth, stippled, or granular texture. Inflammation results in edematous changes and erythematous coloration. Inflamed tissue bleeds readily. Histologically, an increase in collagen fibers, in fibroblasts, and in glycosaminoglycans is seen. Epithelial acanthosis also occurs. The characteristics of gingival hyperplasia related to cyclosporine and calcium channel blockers...

Patients predisposed to peripheral vascular disease can have exacerbation of their illness due to inadequate nutrition, poor protein stores, alcoholism and substance use, use of tobacco, and inability to elevate the legs while sleeping upright. The resulting edema can lead to chronic venous stasis ulcers. The ulcers can become infected with common skin flora or even maggots (fly larvae). For uninfected ulcers, the use of venous support garments, such as Una boots, is a valuable management tool. Una boots are impregnated with antibiotic ointment and require less frequent changes. Infected ulcers require admission. The erythema associated with cellulitis may be difficult to distinguish from deep venous thrombosis or venous stasis changes. When the diagnosis is unclear, an evaluation of venous flow should be undertaken. For lesions infected with maggots, chloroform is a traditional therapy for deinfestation. Chloroform may not be available due to safety issues of combustibility. Ethyl...

Relevant examination of all appropriate systems should then be performed. It should not be assumed that the etiology of the complaint is gynecologic. Other potential explanations of the symptoms should be investigated. The surgical wound should be examined, and a pelvic examination should be performed, including both a sterile speculum and a bimanual examination. The sterile speculum examination should visualize the cervix or, if it is absent, the vaginal cuff, and any evidence of bleeding, discharge, erythema, or cuff or labial cellulitis should be noted. Cervical cultures should be considered. Bimanual examination after a vaginal or abdominal hysterectomy should evaluate for tenderness, masses, and an intact cuff. Following hysteroscopy or dilation and curretage, cervical motion, uterine, and adnexal tenderness should be evaluated. A rectal examination should always be performed to evaluate tenderness or masses.

The oral cavity can be considered a window to the health and immune status of an individual. Although the oral cavity is anatomically unique, it enjoys both the benefits and liabilities of systemic immunity. Perturbations of the T cell compartment of the immune system are often indicated by oral mucosal infections by opportunistic microorganisms, resulting in oral ulcerations. Children with severe combined immune deficiency (SCID) have rampant growth of Candida albicans on their oral mucosal surfaces. Most individuals with T cell deficiencies, as in major histocompatibility complex (MHC) class II deficiency, DiGeorge anomaly, ataxia telangiectasia, Wiskott-Aldrich syndrome and HIV-1 infections, develop oral opportunistic infections most often candidiasis. Infants before the complete development of the T cell

An episode of SSSS frequently begins as a clinically inapparent staphylococcal infection of the conjunctiva, nasopharynx, or umbilicus. The disease course can be divided into three phases initial erythroderma exfoliative and desquamation recovery. Initially, the patient (or parent) notes the sudden appearance of a tender erythroderma, usually diffuse, although localized disease has been described. The involved skin may have a sandpaper texture. Tender erythema is prominent in the perioral, periorbital, and groin regions, as well as in the skin creases of the neck, axilla, popliteal, and antecubital areas. The mucous membranes are spared. The exfoliative stage begins on the second day of the illness. The erythematous skin wrinkles and peels off at sites of minor trauma or with minimal lateral pressure with the examiner's fingertip, illustrating the positive Nikolsky's sign (also found in TEN). Large, flaccid, fluid-filled bullae and vesicles then appear. These lesions easily rupture...

INSULIN Most of the systemic complications of diabetes are related to the microangiopathy caused by the disease.19 Oral manifestations are associated more commonly with insulin-dependent diabetes mellitus but may be associated with non-insulin-dependent diabetes mellitus. Periodontal disease is more common and more aggressive in the diabetic patient. Wound healing postoperatively is delayed, and diabetics are prone to infections secondary to impairment of neutrophil function. In the poorly controlled diabetic patient, gingival erythema and proliferation are common. 37 The poorly controlled diabetic patient is more susceptible to oral candidiasis. Erythematous candidiasis with its central papillary atrophy of the tongue is reported in up to 30 percent of diabetic patients. An increased incidence in benign migratory glossitis is seen in insulin-dependent diabetes. Diabetic sialadenosis, or diffuse nontender enlargement of the parotid salivary glands, is not uncommon. Xerostomia is a...

Patients should be examined for signs of intravenous drug addiction, including needle marks and healed or active superficial cutaneous abscesses, and the heart should be examined for evidence of a new murmur and other signs of endocarditis. Patients attempting to simulate nephrolithiasis can falsify hematuria by biting their buccal mucosa and spitting into the urine sample or by pricking their finger and dipping it into the urine sample. Patients who are suspected of factitious hematuria should be examined for these findings. Patients with factitious acute injury may massage old deformities to create the appearance of erythema and swelling, but this will dissipate over time if the clinician stops the patient from holding the extremity. Patients may self-mutilate, usually with the dominant hand, and seek narcotics. Patients may have evidence of chronic pain or, most commonly, have completely normal physical examination findings. Finally, it is widespread anecdotal experience that such...

Herpes zoster ophthalmicus usually presents with paresthesia and discomfort in the distribution of cranial nerve V -,, followed by the appearance of the typical zoster skin rash. Ocular complications include conjunctivitis, episcleritis, iritis, keratitis, secondary glaucoma, and, rarely, retinitis. Early recognition and treatment is essential to prevent ocular damage. In immunocompetent patients, oral acyclovir may be used in consultation with an ophthalmologist. Immunocompromised patients

The mode of inheritance of most of these complement deficiencies is autosomal recessive. Some examples of other inherited immunological diseases include ataxia telangiectasia, immunologic amnesia and severe combined immune deficiency diseases which are autosomal recessive disorders and hypogammaglobulinemias and chronic granulomatous disease which are X-linked recessive traits.

TREATMENT Initial treatment includes elevation of the affected area, inactivity, and ice compresses to decrease erythema and edema and prevent the spread of venom. Additional treatment for brown recluse spider bites is controversial and includes dapsone, d bridement and skin grafting, and systemic corticosteroids. For small areas of involvement, observation and prevention of secondary infection are recommended. Dapsone, a leukocyte inhibitor, has been reported to prevent progression. Dapsone doses should begin at 25 mg twice daily. Patients should be monitored closely for side effects, including hemolysis and agranulocytosis. Dapsone should not be prescribed to individuals with glucose-6-phosphate dehydrogenase deficiency.

Henoch-Schonlein purpura (HSP) is a disease that manifests symptoms of purple spots on the skin, joint pain, gastrointestinal symptoms, and glomerulone-phritis. HSP is a type of hypersensitivity vasculitis and inflammatory response within the blood vessel. It is caused by an abnormal response of the immune system. The exact cause for this disorder is unknown. The syndrome is usually seen in children, but people of any age maybe affected. It is more common in boys than in girls. Many people with HSP had an upper respiratory illness in the previous weeks. Purpuric lesions are usually over the buttocks, lower legs, and elbows. Besides purpuric lesions, nephritis, angioedema, joint pains, abdominal pain, nausea, vomiting, diarrhea, and he-matochezia can be seen. The scrotum can also be affected in 13 -35 of cases (Ioannides and Turnock 2001). While the testis and or scrotum can rarelybe involved, usually the scrotum is diffusely tender with erythema distributed all over the scrotum....

Progressive systemic sclerosis (PSS) is a multisystem disease that affects the skin, the GI tract, the lung, the heart, and the kidney. In the cutaneous limited form (CREST calcinosis, Raynaud's phenomenon, esophageal hypomotility, sclerodactyly, and telangiectasia), visceral involvement typically takes much longer to become manifest. Kidney involvement is rare in CREST patients, occurring in 1 (19,20).

Irrespective of the mode of triggering, all the clinical manifestations of an allergic reaction occur as a result of the liberation of vasoactive substances. The typical clinical features of anaphylaxis are hypotension, bronchospasm, oedema and the development of a rash (Figure I.4). Cardiovascular collapse is one of the most common early signs (Figure I.5). This is usually the result of vasodilatation and may be compounded by arrhythmias (usually supraventricular tachycardia), hypovolaemia and a reduction in venous return, which will be exacerbated if high inflation pressures are necessary to facilitate ventilation of the lungs. Bronchospasm is variable in its severity from a transient degree of difficulty with ventilation to the situation where gas exchange is impossible despite the use of high airway pressures and slow inspiratory and expiratory times. The presence of wheals and erythema near the point of venous access is usually a sign of localised histamine release which usually...

The larvae parasitise relatively hairless skin that is most likely to be in contact with vegetation. Prized areas include Henry's pocket of the pinnae, the preauricular regions, the interdigital spaces, the eyelids and ventrum. The larvae are visible with the naked eye and tend to congregate in clusters. Infestation results in erythema, papules and crusting, with the degree of pruritus depending on the development of hypersensitivity.

The cutting and repasting of DNA segments during the process of legitimate immune gene rearrangements must surely involve some components of the normal DNA repair machinery. Increased frequency of chromosomal aberrations are indeed observed in normal cells following severe DNA damage and in lymphocytes of individuals with a DNA repair deficiency. Several DNA repair deficiencies are also characterized by an increased risk of malignancies. Patients with ataxia telangiectasia (AT), for example,

Usually diabetic foot infections occur in a preexisting ulcer. Peripheral neuropathy is the greatest risk factor for foot ulcers and infection,60 and patients often have no complaints of pain. Patients will usually have discharge from the ulcer, erythema, swelling, and unexplained hyperglycemia. If there is no draining ulcer but the foot is erythematous and swollen, a Charcot foot (diabetic neuroarthropathy) should be considered and it is unlikely that a non-inflamed ulcer is infected.61 non-limb-threatening, which have &lt 2 cm of surrounding erythema extending from the ulcer, not a full-thickness ulcer and no systemic signs of toxicity limb-threatening, which have &gt 2 cm of surrounding erythema, full-thickness ulcer, presence of an abscess or soft-tissue gas, rapid progression, and signs of systemic toxicity.54-61

Undoubtedly protect against sunburn, but evidence for a role in the prevention of skin cancers is still somewhat equivocal.1,2 The concept of a sunscreen effectiveness index (ratio) is attributed to Schulze and Greiter, who proposed the specific term sun protection factor (SPF), and the associated method for assessing SPF.3 SPF activity is the ratio of the least amount of UV energy required to produce erythema (reddening of the skin) on sunscreen-protected skin to the amount of energy to produce the same effect on unprotected skin.

Local tissue reactions were confined to the treatment site and included erythema, swelling, desquamation, erosions and eschar in most patients. Hyperpigmentation was observed in 83 of patients but typically cleared up by follow up. Forty-seven per cent of patients had ulcerations at the treatment site. The lowest incidence and severity of reactions occurred with 0-5 ml 5-FU epinephrine gel three times weekly for 2 weeks.

Local radiation injury from doses above 2 to 3 Gy (200 to 300 rad) may result in erythema with associated hyperesthesia and itching. Ihese signs occur within hours after exposure and are transient. Depending on the dose received, the erythema may reappear. Early onset of the initial erythema and quick reappearance of erythema correspond to higher doses. With doses below 3 Gy (300 rad), the erythema may not reappear. Doses of 6 Gy (600 rad) result in reoccurrence of significant erythema in 1 to 3 weeks. Much higher doses may result in prompt and persistent erythema.10 Ihese skin manifestations may appear similar to thermal burns. However, unlike thermal burns, cutaneous radiation injury may be associated with waves of transient erythema described above, as well as with a delayed onset of pain, followed by a more prolonged and severe pain. Another important distinction of radiation injury is that the clinical changes evolved over a more prolonged time period. Ihe exception is very high...

In 1899, Caesar Boeck described a patient with lym-phadenopathy and multiple skin nodules with characteristic epithelioid granulomas on histologic examination he proposed the term 'multiple benign sarkoids' for this condition. The view that sarcoidosis is a multisystem disease was first clearly expressed by Jorgan Schaumann in 1914. Thirty years later, Sven Lofgren observed that sarcoidosis frequently presents with asymptomatic bilateral hilar adenopathy or with erythema nodosum. For many years, sarcoidosis was conceptualized as a disease of suppressed immunity with peripheral lymphopenia and cutaneous anergy. Landmark studies of pulmonary sarcoidosis in the late 1970s led to a fundamental reappraisal of sarcoidosis as a disease of enhanced, cell-mediated immune activity associated with granulomatous inflammation.

Superficial thrombophlebitis of the lower extremities is most frequently secondary to stasis in varicose veins. It is usually aseptic. The patient complains of redness and warmth of the affected vein. If there is no evidence of surrounding cellulitis or lymphangitis, the patient is treated with local heat and elevation. Suppurative superficial thrombophlebitis is characterized by erythema, palpable tender cord, lymphangitis, and pain. Suppurative thrombophlebitis requires excision of the affected vein.

On physical examination, neck vein and upper chest vein distention may be apparent. Facial plethora and telangiectasia often are prominent, but edema of the face and arms is generally subtle. Papilledema on funduscopic examination indicates critical intracranial pressure and justifies early diuretic therapy. A palpable supraclavicular mass due to direct tumor extension occasionally can be noted with tumors of the superior mediastinum. Chest radiography will demonstrate an enlarged mediastinum and possibly an isolated primary lesion in the lung parenchyma.

Any individual who is confined to bed can develop a decubitus ulcer. Poor nutrition, vascular insufficiency (e.g., diabetes mellitus), accumulation of urine and feces due to incontinence, and friction arising from the actions of caregivers (e.g., repositioning patient on the bed) are contributing factors (69,71-75,77). Rubbing of the skin likely removes an already devitalized epidermis (78). The area of pressure first shows erythema (stage 1), then proceeds to a blister or superficial ulcer (stage 2), full thickness cutaneous necrosis with extension into the subcutaneum and fascia (stage 3), and eventual involvement of underlying muscle and supporting structures (bone, tendon, joint capsule stage 4 69,71,73-75 ).

Cool, clammy skin is an obvious sign of shock. Spider angiomata, palmar erythema, jaundice, and gynecomastia suggest underlying liver disease. Petechiae and purpura suggest an underlying coagulopathy. Skin findings may be suggestive of the Peutz-Jeghers, Rendu-Osler-Weber, or Gardner syndromes. A careful ENT examination may occasionally reveal an occult bleeding source that has resulted in swallowed blood and subsequent coffee-ground emesis or melena. The abdominal examination may disclose tenderness, masses, ascites, or organomegaly. A rectal examination is indicated to detect the presence of blood, its appearance (bright red, maroon, or melanotic), and the presence of masses.

Acute, severe infections of the sinuses are infrequent during childhood. Such patients often have a history of headache and an elevated temperature. Findings include fever, localized swelling and or erythema, and facial tenderness. A mucopurulent discharge usually accompanies severe sinusitis but may also indicate a nasal foreign body when unilateral.

Burns are categorized by depth into first, second, and third degree. First- and second-degree burns are both partial thickness, whereas third-degree burns involve complete destruction of all skin appendages. The most superficial type of heat-related damage, erythema, usually resolves in a few days. Even extensive first-degree burns usually heal in 10 to 14 days with no scarring. They are accompanied by blistering and are very painful. Second-degree burns heal more slowly, are relatively painless, and heal with scarring if not treated. Third-degree burns are painless, heal by granulation tissue, and scar if left untreated.12 Occasionally, most often in black-skinned races, burns are complicated by keloid scar formation characterized by tumor-like growth extending beyond the original injury.

Vulvar pruritus is the dominant feature. Women may also complain of dysuria (external rather than urethral), soreness, irritation, and dyspareunia. There is often little or no discharge that which is present is typically white and clumpy. Physical examination often reveals erythema of the vulva and vaginal mucosa. The discharge is thick, adherent, and cottage cheese-like.

These are the most common tests in atopy and they are characterized by an itchy wheal and erythema at the introduction of an antigen into the skin in an allergen-sensitized individual. The reaction site is small, allowing a great number of tests to be done at once. The skin prick test consists of a biphasic reaction. The immediate phase lasts about 1 h, and is caused by the release of histamine from degranu-latory mast cells. This is often followed by a late reaction, lasting several hours, which is generally

Mycoplasma pneumoniae infections are a common cause of pneumonia, upper respiratory infections, and bronchitis in children between 5 and 19 years of age. The most frequent presenting clinical findings in children and adults are fever, cough, sore throat, malaise, headache, chills, and rash. An erythematous maculopapular rash, the most frequent presentation, is located on the trunk and may be discrete or confluent. However, the most frequently reported exanthem is consistent with erythema multiforme and Stevens-Johnson syndrome, with lesions occurring primarily on the trunk, legs, and arms. The rash occurs most commonly during the febrile period. An enanthem of generalized ulcerative stomatitis or pharyngitis-tonsillitis associated with the exanthem is common. The diagnosis can be confirmed by the use of either serum cold agglutinins or several specific antibody tests.

Pneumoperitoneum related to signs of necrotizing enterocolitis is an absolute indication for surgical repair. Recent data indicate that paracentesis indicative of intestinal gangrene prior to intestinal perforation may be an indication for surgery. Persistent acidosis, oliguria, abdominal wall erythema, and portal vein air are associated with advanced disease. The surgical repair consists of removal of the segment of involved bowel and an enterostomy. Reanastomosis is usually performed after 4 to 6 weeks of bowel rest.

Cutaneous injuries encompass the spectrum of blunt force injury from erythema and bruising (which may be parallel and linear depending upon which part of the cuff is contacting the skin Figure 7.6) to abrasions and lacerations. Bony injuries are uncommon. Compression neuropathies have been documented, with the risk increasing with duration of application and the degree of neurologic impairment, as in acute alcohol intoxication.18 Fig. 7.6. Erythema and intradermal bruising associated with application of police handcuffs. Fig. 7.6. Erythema and intradermal bruising associated with application of police handcuffs.

Oxidative stress is implicated in the inflammatory demy-elination that characterizes multiple sclerosis suggesting GST polymorphisms may be associated with disability. In 177 patients with disease duration over 10 years, GSTM3 AA (OR 2.4) and homozygosity for both GSTM1*0 and GSTP1*Ile105-encoding allele (OR 5.0) were linked with severe disability suggesting that long-term prognosis in MS is influenced by GST-mediated ability to remove toxic products of oxidative stress. 1 Exposure to ultraviolet radiation also results in local oxidative stress in skin. Response to such exposure, examined as minimal erythema dose, has been shown to be mediated by GSTM1 and GSTT1 genotype in a gene dosage-dependent manner. 19 Furthermore, nonmela-noma skin cancer has also been linked to these poly-

Anaphylactoid reactions are very rare with amide local anaesthetics, and some of those reported have been due to preservatives (such as metabisulphite and methylparaben). Effects range from local erythema and swelling to systemic hypotension and bronchospasm. More commonly, the reactions are due to co-administration of adrenaline, intravascular injection or psychological effects (vaso-vagal episodes). Reactions are relatively common with esters and cross sensitivity may occur. The metabolism of procaine produces para-amino benzoic acid (PABA) which may be allergenic.

This can be quite dramatic, with erythema and rash all over the body surface, and swelling of the face, lips and tongue. However, if confined to the skin and oral mucosa, it is usually not life-threatening. This reaction responds to oral or parentral antihistamine in addition to corticosteroids. Treatment may need to be continued for a few days until symptoms have completely subsided. Unless the cause of the reaction is known, the patient should be referred to an allergy clinic for evaluation.

Heterotopic ossification (HO) is the formation of bone in the soft tissues.17 The mechanisms of the formation of heterotopic bone are not precisely known. In spinal-cord-injured patients, it is more common among those with spasticity. Symptoms may present as early as 1 month after injury. Pain is prominent in other patients with HO but is often absent in spinal-cord-injured patients. For spinal-cord-injured patients, the commonest symptom of HO is a decreased range of motion. Other findings are a change in spasticity, fever, erythema, joint effusion, and swelling.17 The differential diagnosis includes DVT, infection, and tumor. Sometimes HO and DVT are seen together.

It has been recently shown that 20 of the children with steroid rosacea had at least one close blood relative with rosacea. Fair complexion, blond hair and green blue eyes are characteristic of patients with rosacea. In England, for example, 48 of patients with rosacea had this skin type. How this frequency compares with that of the general British population is not known. About 0-1 of coloured people are also affected by rosacea, as reported by an old American observation. Rosacea occurs more frequently in women than in men (3 1). Typically, rosacea is a multistage disease and the prevalence may change according to the stage s at which the diagnosis is made. The stages are the flushing stage or transitory congestive redness, the erythrosis stage or persistent teleangiectatic redness, the papulopustular stage and the phyma stage. Only a minority of patients with the first two stages of the disease progress to the papulopustular stage and even fewer to the phyma...

DNA-PKcs is a member of a subfamily of phospho-inositol (PI) 3-kinases called PI 3-K-like kinases (PIKKs). This subfamily has protein kinase activity, in contrast to the lipid kinase activity of the PI 3-Ks. DNA-PKcs at 460 kDa is one of the largest PIKKs and other family members include ataxia telangiectasia mutated protein (ATM) and ataxia telengiectasia and Rad 3-like protein (ATR). PI 3-Ks have a conserved kinase domain at the C terminus and PIKKs in addition have a small region at the extreme C terminus that is required for protein kinase activity. Although in vitro, DNA-PK can phos-phorylate many of the proteins phosphorylated by ATM and ATR, in vivo, the three PIKKs have distinct functions. The in vivo substrates of DNA-PK have not

On physical examination of patients with typical GABHS, there are erythematous tonsils, discrete tonsillar exudate enlarged, tender anterior cervical lymph nodes and uvula edema. Often, palatal petechiae accompany the marked erythema of the throat and tonsils. Viral and bacterial agents often present with a more vesicular and petechial pattern on the soft palate and tonsils of the pharynx and no exudate. Clinical differentiation between viral and bacterial infection can be difficult.

The poorly haired, pale and non-pigmented areas on the pinnae, nasal planum and muzzle are susceptible to the influence of ultraviolet radiation and the development of erythema, crusts, ulceration and plaques. These lesions are indistinguishable from the invasive form of SCC and SCC in situ. size, soft to firm, raised nodules plaques. Poorly to well-circumscribed. May be erythematous, ulcerated and pruritic

Genital and perineal discomfort worsens, leading to pain, itching, burning sensation, erythema, swelling, and eventual skin necrosis. There may be a purulent discharge with a feculent odor. The pain may subside as neural damage develops (Corman et al. 1999). Crepitus may be difficult to elicit, due to pain on palpation, but is present in up to 50 -60 of cases (Corman et al. 1999 Benizri et al. 1996).

CLINICAL FEATURES Most Latrodectus bites are almost immediately mild to moderately painful. The pain often begins as a pinprick sensation at the bite site but may spread quickly to include the entire bitten extremity.12 Erythema appears approximately 20 to 60 min after the bite. In over 50 percent of cases, the initial erythema evolves into a lesion resembling a target, with a diameter of about 1 to 2 cm ( Fig 188-6). Victims frequently complain of muscle cramp-like spasms in large

Nonvalvular infections of the heart involve the endocardium, the myocardium, and the pericardium. 23 In addition, pacemakers automatic, implantable cardioverter-defibrillators and other cardiac devices may become infected in the subcutaneous device pocket or along the vascular tracks leading to and including the heart. Most commonly these devices become infected at the device pocket, where they are more readily diagnosed because of tenderness and erythema easily noted on physical examination. Myocardial abscesses and mural endocarditis are discussed here because of their similarities to valvular endocarditis. These two conditions are difficult to diagnose because their signs and symptoms are subtle.

Staphyloccal exfoliatin(s) - a family of toxins important in staphylococcal scalded skin syndrome -cause cleavage of desmosomes in the stratum granu-losum. Whether the primary site of action is external, i.e. on desmosomal proteins, or internal on cytoske-letal proteins is not clear. The toxins have demonstrable esterase activity and amino acid sequence analyses predict 'active serine' protease activity. They bind selectively to an intracellular skin protein, pro-filligrin, but there is no evidence of ability to enter intact skin cells. Purified exfoliatin will split the skin but does not per se cause the erythema associated with the disease. This suggests a role for other factors such as staphylococcal 8-hemolysin.

Histologic examination for evidence of inflammatory reaction can be performed and may be helpful. Cutaneous erythema is characterized by dilated capillaries, occasional necrotic epidermal cells, condensation of nuclear chromatin, swelling of epidermal cell nuclei, and edema of the subepidermal connective tissue.43 First-

Toxic epidermal necrolysis is an explosive dermatosis characterized by tender erythema, bullae formation, and subsequent exfoliation. Patients may be systemically ill on presentation. Many authorities consider the SJS variant of EM and TEN as the same process.2 TEN is found in all age groups without predilection to gender. The syndrome has multiple possible etiologies with medications representing the most common cause.1,2,,5,6 Sulfa and penicillin antibiotics, anticonvulsants, and oxicam NSAIDs are the most frequent drug triggers for TEN.78 Other causes include malignancy and human immunodeficiency virus (HIV).6 In many cases, an etiology is not found. Patients with TEN often present with a one- to two-week prodrome of malaise, anorexia, arthralgias, fever, or upper respiratory infection symptoms. Skin tenderness, pruritus, tingling, or burning may be found at this time. Skin signs begin with a warm erythema, initially only involving the eyes, nose, mouth, and genitalia, but later...

CLINICAL FEATURES The bite of a black widow spider may or may not be painful. Black widow spiders release a neurotoxic venom upon biting the victim. Local reaction is minimal, with mild erythema and edema. Within 20 to 40 min of the bite, the victim begins to develop muscle cramps locally and then generally. A painful, rigid abdomen, mimicking an acute abdomen, is seen. Other systemic symptoms include nausea, vomiting, anxiety, diaphoresis, respiratory distress, urinary retention, hypertension, shock, and coma. In less than 1 percent of cases, death results. Symptoms generally peak in 2 to 3 h and resolve over 2 to 3 days.

Several related syndromes overlap with AT. Nijmegen breakage syndrome (NBS) shares t(7 14) translocations, radiosensitivity, immunodeficiency and cancer susceptibility with AT but these patients do not have ataxia, telangiectasia, nor elevated AFP NBS patients are microcephalic and mentally retarded. AT patients are usually not mentally retarded. Berlin breakage syndrome is very similar

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.